218 - Bronchopulmonary Dysplasia and Pulmonary Hypertension in Very Preterm Infants Increase Risk for Brain Abnormalities at Term

Poster Number: 218
Publication Number: 218.221

Fotios Spyropoulos, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, United States; Ashley Cunha, Pediatric Newborn Medicine, Brigham and Women's Hospital, Haverhill, MA, United States; Panagiotis Antiochos, Brigham and Women's Hospital, Boston, MA, United States; Maria Niccum, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Katherine Bell, Brigham and Women's Hospital, Boston, MA, United States; Mohamed El-Dib, Harvard Medical School, Boston, MA, United States; Mandy B. Belfort, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Terrie E. Inder, Harvard Medical School, Boston, MA, United States; helen christou, Brigham and Women's Hospital, NEWTON, MA, United States

Background: Bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) are common morbidities among survivors of prematurity. The association of BPD with adverse neurodevelopmental outcomes is well established, with recent data demonstrating even worse outcomes when BPD is complicated by PH. Term-equivalent brain magnetic resonance imaging (MRI) can define brain injuries that predict later neurodevelopment, but the relationships between BPD, PH, and brain abnormalities at term equivalent age are unknown.

Objective: To determine the extent to which BPD and PH are independently associated with brain abnormalities detected by term-equivalent MRI.

Design/Methods: We studied a cohort of 59 infants born at < 32 weeks gestational age (GA) who underwent brain MRI at term (≥36 weeks postmenstrual age). We ascertained the presence of BPD (NICHD 2016 definition) and PH (echocardiographic criteria- systolic septal flattening or right ventricular pressure ≥35 mmHg [estimated by tricuspid regurgitant jet velocity or shunt velocity]) from the medical record. From brain MRIs, we used the Kidokoro method to determine global brain abnormality (GBA) scores and subscale scores for abnormalities in the white matter, cortical gray matter, deep gray matter, and cerebellum. Participant characteristics and brain abnormality scores were compared among 4 groups: non-BPD and non-PH (n=29), non-BPD with PH (n=7), BPD without PH (n=13), and BPD with PH (n=10) using chi-squared and Kruskal–Wallis tests. We estimated associations of BPD/PH group with global brain abnormality score, adjusting in linear regression for potential confounders.

Results: Groups differed with respect to GA, APGAR scores (1 min), birth weight (BW) and cerebellum injury scores (Table 1). In univariate analyses, BPD and PH were associated with worse GBA scores. There was an inverse correlation between both GA and BW with GBA scores (Table 2). After controlling for GA and small for gestational age (SGA) status in the multivariate linear regression analysis, having both BPD and PH was associated with higher GBA scores (2.9 points, 95% CI: 0.2, 5.7) (Table 3).Conclusion(s): Preterm infants with concurrent BPD and PH have higher total brain abnormality scores at term corrected age compared to infants without BPD and PH. These findings indicate that infants with BPD and PH are at heightened risk for brain abnormalities at term equivalent age that predict adverse neurodevelopmental outcomes and may benefit from more intensive surveillance and intervention after NICU discharge.
Table 1: Demographics, baseline characteristics, and brain abnormality scores of study cohort
Table 2: Univariate associations of clinical characteristics with global brain abnormality score